Survival of trauma patients requiring massive transfusion protocol activation: A retrospective cohort study at a tertiary hospital in Malaysia

BACKGROUND: Trauma is one of the main causes of morbidity and mortality worldwide. Understanding the factors affecting the survivability of trauma patients is crucial, especially those requiring the activation of the massive transfusion protocol. This study aimed to determine survival outcomes and identify factors associated with mortality among trauma patients requiring massive transfusion activation. MATERIALS AND METHODS: This was a retrospective cohort study of 71 trauma patients who required activation of the massive transfusion protocol. The trauma patients were divided into Survivor (n = 41) and Non-survivor groups (n = 30). The activation criteria for massive transfusions were an assessment of blood consumption score ≥2. RESULTS: The hospital mortality rate for trauma patients who required activation of the massive transfusion protocol was 42.3%. Most of the patients were male (90.1%), of Malay ethnicity (49.3%), and had blood group O (40.8%). The commonest cause of trauma was road traffic accidents (84.5%). Patients with severe Glasgow Coma Scores had approximately 4.2 times higher odds of mortality compared with those with non-severe Glasgow Coma Scores (p-value = 0.014). Haemoglobin level was independently associated with outcome, with lower haemoglobin levels observed among non-survivors (adjusted odds ratio: 1.38; 95% CI: 1.03-1.85; p-value = 0.030). CONCLUSIONS: The survivability of trauma patients who need massive transfusion protocol activation was associated with Glasgow Coma Score and haemoglobin level on arrival. It is crucial to determine factors that affect the survivability of trauma patients for the early identification of those at risk and to initiate prompt management and resuscitation in the future.